the nose, mouth, and throat. These substances include
acids, alkalies, phenols, and some chemical warfare
agents. Direct contact with these substances will cause
inflammation or chemical burns in the affected areas.
Consult the Chemical Burns section of chapter 4 and
the Chemical Agents section of chapter 8 of this
manual for treatment.
INJECTED POISONS AND
Injection of venom by stings and bites from
various insects and arthropods, while not normally
life-threatening, can cause acute allergic reaction that
can be fatal. Poisons may also be injected by snakes
and marine animals.
Bee, Wasp, and Fire Ant Stings
Stings from bees, wasps, and ants account for more
poisonings than stings from any other insect group.
Fortunately, they rarely result in death.
majority of stings cause a minor local reaction at the
injection site, with pain, redness, itching, and swelling.
These symptoms usually fade after a short time. A
small percentage of these stings can cause an allergic
victim severe anaphylactic reactions, presenting with
itching, swelling, weakness, headache, difficulty
breathing, and abdominal cramps. Shock may follow
quickly, and death may occur.
The following first aid measures are recommended
for all but minor, local reactions to bites or stings:
1. Closely monitor vital signs (and the whole
patient), and remove all rings, bracelets, and
2. Remove stingers without squeezing additional
venom (remaining in poison sacs attached to
stingers) into the victim. To do this, scrape along
the skin with a dull knife (as if you were shaving
the person). The dull blade will catch the stinger
and pull it out.
3. Place an ice cube or analgesic-corticosteroid
cream or lotion over the wound site to relieve
pain. Do NOT use tobacco juice, saliva, or
4. For severe allergic reactions (generalized
itching or swelling, breathing difficulty, feeling
faint or clammy, unstable pulse or blood
pressure), immediately give the victim a
subcutaneous injection of 1:1000 aqueous
solution of epinephrine. Dosage is 0.5 cc for
adults and ranges from 0.1 to 0.3 cc for children.
5. Patients with severe allergic reactions should be
evacuated immediately to a medical facility.
About 40 species of scorpions (fig. 5-2) exist in
Centruroides exilicauda may cause severe
effects. Most dangerous species are found from North
Africa to India.
Scorpion stings vary in severity,
depending on the species of the scorpion and the
amount of poison actually injected. They cause severe
pain in the affected area.
Mild reactions may include local swelling, skin
discoloration, swollen lymph nodes near the sting area,
itching, paresthesias (pins and needles, numbness),
and even nausea and vomiting.
The duration of
symptoms is less than 24 hours.
The following first aid treatment should be given
for scorpion stings:
1. Place ice over the sting site (cool the area for up
to 2 hours). Do NOT use tobacco juice, saliva,
or other concoctions.
2. Elevate the affected limb to approximately heart
3. Give acetaminophen for minor pain.
4. Calcium gluconate, 10 ml of 10 percent
solution, may be given intravenously to relieve
5. Valium may be used to control excitability and
6. An antivenom is available for severe bites by
(also called bark
scorpion, it is the scorpion found in Mexico
and the American southwest). It is available
from the Antivenom Production Laboratory,
Arizona State University, Tempe, Arizona
85281, phone (602) 965-6443 or (602)
965-1457, and from Poison Control in Phoenix,
phone (602) 253-3334.
Morphine and meperidine
hydrochloride may worsen the respiratory